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Tuesday, September 1, 2009

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Shirley Keck, a 61-year-old mother of five, was having trouble breathing one Sunday afternoon, so her daughter, Becky Hartman, rushed her to the emergency room at Wesley Hospital in Wichita, Kan.

Doctors there thought Keck had pneumonia and admitted her. But for the next seven hours, Hartman sat by her mother's bedside watching her condition deteriorate, and seeing her struggle for each breath. She said she repeatedly tried to get help from the nurses.

"I begged for help," she said. "We had plenty of time to get help, and we got none."

Keck did not have pneumonia. She was actually having a heart attack that was causing liquid to fill her lungs.

But because her primary nurse was overburdened -- allegedly caring for 20 patients, more than the hospital's own guidelines recommend -- the nurse didn't have time to observe Keck until she had to be resuscitated.

As a result of her heart attack, Keck suffered brain damage and was paralyzed. Her family sued the hospital and won $2.7 million.

Nursing care in America's hospitals has reached a critical shortage -- the worst in 50 years, according to Peter Buerhaus, the assistant dean of Vanderbilt School of Nursing, who has studied the problem. To make matters worse, just as there are fewer nurses, the population is aging and in need of more medical care.

More Nurses Needed, Fewer Available

Hartman said she didn't sue for the money.

"I wanted them, as I wheeled my mother into that courtroom, to see what their decision to run the hospital shorthanded cost somebody," she said.

So far, it is the only successful malpractice lawsuit against a hospital citing inadequate nursing. But amid an ongoing staffing shortage, it may not be the last.

Hospitals are under pressure to keep control of their bottom lines, and nurses account for a large part of their budgets. But a recent study published in the Health Affairs medical journal found hiring more nurses could actually save a hospital money in the long run. The study found 6,700 patient deaths and 4 million days of hospital care could be avoided each year by increasing staff of registered nurses.

However, training new nurses is the problem. Last year, nursing schools had to turn away 125,000 applicants because they didn't have enough faculty to teach them. Many nursing professors are retiring just when they're needed most.

"Today, we have a cruel and unfortunate development, said Buerhaus, who co-authored the Health Affairs study. "Our current work force will get older and older and retire in large numbers in the next decade just as we see the aging of baby boomers, all 80 million of them, beginning to turn 65 and consuming more health care."

To make matters worse, patients in hospitals today are sicker than 20 years ago. In the past, a nurse could take care of more patients because some of them were recovering from minor operations. But now, with so many outpatient procedures, an overnight hospital stay is a rarity.

"We have a much higher acuity level patient who requires a lot more nursing care and we have less nurses to provide that care," said Dr. Timothy Babineau, the chief medical officer at the University of Maryland's Medical Center.

Protect Yourself

The picture may be gloomy, but prospective patients and their loved ones can try to protect themselves by finding out a hospital's nurse-to-patient ratio. The American Nurses Association Web site lists magnet hospitals -- institutions recognized for excellence in nursing care, including good nurse-to-patient ratios -- at http://ana.org/ancc/magnet/consumer/locations.html.

According to the association, there is no magic number for that ratio because it varies depending on what tasks a particular nursing unit performs and whether they tend to work days or nights, when patients primarily sleep.

For instance, intensive care units need more nurses on duty than general medical wards. Ideally, an ICU nurse should have no more than two patients. But the association recommends no more than six patients per nurse in any unit.

Keck's family says it will continue to talk about what happened to her as a result of too few nurses, to ensure no other family has to go through what they experienced.

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